| |
Important Note: The following information
is provided for your education. It should not be relied upon for
personal diagnosis or treatment. If you believe that a
particular therapy applies to you or someone you care about, be
sure to consult a doctor before trying it.
Cataracts
Research: 2002-2006
Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003169.
Multifocal versus monofocal intraocular lenses after cataract
extraction.
Leyland M, Pringle E.
Frimley Park NHS Trust, Department of Ophthalmology, Portsmouth Road, Frimley,
Surrey, UK.
BACKGROUND: Good unaided distance visual acuity is now a realistic expectation
following cataract surgery and intraocular lens (IOL) implantation. Near vision
however still requires additional refractive power usually in the form of
reading glasses. Multiple optic (multifocal) IOLs are available which claim to
allow good vision at a range of distances. It is unclear whether this benefit
outweighs the optical compromises inherent in multifocal IOLs. OBJECTIVES: The
objective of this review was to assess the effects of multifocal IOLs, including
effects on visual acuity, subjective visual satisfaction, spectacle dependence,
glare and contrast sensitivity, compared to standard monofocal lenses. SEARCH
STRATEGY: We searched the Cochrane Central Register of Controlled Trials
(CENTRAL) (which includes the Eyes and Vision Group Trials Register) on The
Cochrane Library (2006, Issue 3), MEDLINE (1966 to July 2006), EMBASE (1980 to
July 2006), NRR (2006, Issue 3) and PUBMED searched on 25 July 2006, limit: 90
days (entry date). We searched the reference lists of relevant articles and
contacted investigators of included studies and manufacturers of multifocal
intraocular lenses for information about additional published and unpublished
studies. SELECTION CRITERIA: All randomised controlled trials comparing a
multifocal IOL of any type with a monofocal IOL as control were included. Both
unilateral and bilateral implantation trials were included. DATA COLLECTION AND
ANALYSIS: Data were collected and trial quality was assessed. Where possible,
statistical summary measures were calculated otherwise data were tabulated. MAIN
RESULTS: Ten trials were identified, and a further three are pending review.
There was significant variability between the trials in which outcomes were
reported. Unaided distance acuity was similar in multifocal and monofocal IOLs (standardised
mean difference (SMD) 0.03, 95% Confidence Interval (CI) -0.13 to 0.19). There
was no statistical difference between multifocal IOLs and monofocals with
respect to the proportion of participants achieving 6/6 best corrected visual
acuity (Peto odds ratio (OR) 1.05, 95% CI 0.67 to 1.63). Unaided near vision was
improved with the multifocal IOLs. Total freedom from use of glasses was
achieved more frequently with multifocal than monofocal IOLs (OR for spectacle
dependence 0.17, 95% CI 0.12 to 0.24). Adverse effects included reduced contrast
sensitivity and the subjective experience of haloes around lights. AUTHORS'
CONCLUSIONS: Multifocal IOLs are effective at improving near vision relative to
monofocal IOLs. Whether that improvement outweighs the adverse effects of
multifocal IOLs will vary between patients. Motivation to achieve spectacle
independence is likely to be the deciding factor.
-----
Cochrane Database Syst Rev. 2006 Oct 18;(4):CD001323.
Surgical interventions for age-related cataract.
Riaz Y, Mehta JS, Wormald R, Evans JR, Foster A, Ravilla T, Snellingen T.
Moorfields Eye Hospital, City Road, London, UK. yasmin.riaz@gmail.com
BACKGROUND: Cataract accounts for 50% of blindness globally and remains the
leading cause of visual impairment in all regions of the world, despite
improvements in surgical outcomes (WHO 2005). This number is expected to rise
due to an aging population and increase in life expectancy. Although cataracts
are not preventable, their surgical treatment is one of the most cost-effective
interventions in healthcare. OBJECTIVES: To compare the effects of different
surgical interventions for age-related cataract. SEARCH STRATEGY: We searched
CENTRAL, MEDLINE, EMBASE up to July 2006, NRR Issue 3 2005, the reference lists
of identified trials and we contacted investigators and experts in the field for
details of published and unpublished trials. SELECTION CRITERIA: We included
randomised controlled trials (RCTS). DATA COLLECTION AND ANALYSIS: Two review
authors independently extracted data and discrepancies were resolved by
discussion. Where appropriate, risk ratios, odds ratios and weighted mean
differences were summarised after assessing heterogeneity between the studies.
MAIN RESULTS: We identified 17 trials that randomised a total of 9627 people.
Phacoemulsification gave a better visual outcome than extracapsular surgery but
similar average cost per procedure in Europe but not in poorer countries.
Extracapsular surgery with posterior chamber lens implant and ICCE with or
without an anterior chamber intraocular lens (IOL) implant gave acceptable
visual outcomes but extracapsular surgery had less complications. Manual small
incision surgery provides better visual outcome than ECCE but slightly inferior
unaided visual acuity compared to phacoemulsification. AUTHORS' CONCLUSIONS:
This review provides evidence from seven RCTs that phacoemulsification gives a
better outcome than ECCE with sutures. We also found evidence that ECCE with a
posterior chamber lens implant provides better visual outcome than ICCE with
aphakic glasses. The long term effect of posterior capsular opacification (PCO)
needs to be assessed in larger populations. The data also suggests that ICCE
with an anterior chamber lens implant is an effective alternative to ICCE with
aphakic glasses, with similar safety. Phacoemulsification provides the best
visual outcomes but will only be accessible to the poorer countries if the cost
of phacoemulsification and foldable IOLs decrease. Manual small incision
cataract surgery provides early visual rehabilitation and comparable visual
outcome to PHACO. It has better visual outcomes than ECCE and can be used in any
clinic that is currently carrying out ECCE with IOL. Further research from
developing regions are needed to compare the cost and longer term outcomes of
these procedures e.g. PCO and corneal endothelial cell damage.
-----
J Cataract Refract Surg. 2006 Oct;32(10):1672-7.
Primary intraocular lens implantation in infants: complications
and visual results.
Lundvall A, Zetterstrom C.
St Erik's Eye Hospital, Karolinska Institute, Stockholm, Sweden. anna.lundvall@sankterik.se
PURPOSE: To evaluate the complications and visual results in a consecutive
series of patients having cataract extraction with intraocular lens (IOL)
implantation in the first year of life. SETTING: St. Erik's Eye Hospital,
Stockholm, Sweden. METHODS: This retrospective study comprised 28 children (31
eyes) who had cataract surgery with primary IOL implantation. RESULTS: The
median age at surgery was 2.5 months (range 8 days to 10 months). The median
follow-up was 36 months. Two newborns with persistent fetal vasculature (PFV)
who had surgery at 8 days and 17 days, respectively, developed intraoperative
vitreous hemorrhage; a retinal detachment developed in 1 of the eyes.
Intraocular lens luxation occurred in 2 infants with PFV. Seventy percent of
eyes developed opacification of the visual axis that required additional
surgery. Chronic glaucoma developed in 2 eyes and transitory glaucoma in 1 eye.
Two of the glaucoma cases occurred in eyes with PFV. In 7 eyes of 4 infants with
bilateral cataract, the median visual acuity was 20/63 (range 20/25 to 20/100).
In 12 infants with unilateral cataract without PFV, 7 achieved a visual acuity
between 20/32 and 20/200 (median 20/63), 4 achieved counting fingers (CF), and 1
achieved light perception. In 12 eyes with PFV, 2 achieved a visual acuity of
20/200 and the rest achieved CF or worse. CONCLUSIONS: After-cataract with
membrane formation was the main complication in infants with primary IOL
implantation. The glaucoma incidence was low at the last follow-up.
-----
J Cataract Refract Surg. 2006 Oct;32(10):1632-7.
One-year follow-up of bag-in-the-lens intraocular lens
implantation in 60 eyes.
De Groot V, Leysen I, Neuhann T, Gobin L, Tassignon MJ.
Department of Ophthalmology, University of Antwerp, Edegem, Belgium.
veva.de.groot@uza.be
PURPOSE: To report the feasibility and clinical results of implanting a
bag-in-the-lens intraocular lens (IOL) designed to prevent posterior capsule
opacification after cataract surgery. SETTING: Departments of Ophthalmology,
University of Antwerp, Antwerp, Belgium, and University of Munich, Munich,
Germany. METHODS: This prospective study comprised 63 eyes (55 patients; 7
children, 48 adults) scheduled for cataract surgery and bag-in-the-lens IOL
implantation. A posterior curvilinear capsulorhexis the same size as the
anterior capsulorhexis was created for IOL insertion. After surgery, lens
epithelial cell (LEC) proliferation was documented every 6 months with a minimum
follow-up of 12 months. RESULTS: Sixty of 63 eyes (95%) had implantation of the
bag-in-the-lens IOL. Conversion to a conventional IOL was necessary in 2 cases.
In 1 eye, postoperative luxation of the IOL into the vitreous occurred as a
result of an oversized anterior and posterior capsulorhexis. Three eyes had
early postoperative iris incarceration in the lens groove that required surgery.
No LEC proliferation on the optic occurred during a mean follow-up of 22.7
months (range 12 to 64 months); LEC proliferation was confined to the peripheral
capsular bag. CONCLUSION: Lens epithelial cell proliferation was mild and
confined to the periphery of the capsular bag during follow-up, and the
bag-in-the-lens IOL optic remained clear.
-----
J Cataract Refract Surg. 2006 Oct;32(10):1627-31.
Posterior capsule opacification after implantation of a
hydrophilic or a hydrophobic acrylic intraocular lens: one-year follow-up.
Kugelberg M, Wejde G, Jayaram H, Zetterstrom C.
St Erik's Eye Hospital, Karolinska Institute, Stockholm, Sweden. m.kugelberg@sankterik.se
PURPOSE: To evaluate the effect of hydrophilic and hydrophobic single-piece
acrylic intraocular lenses (IOLs) on posterior capsule opacification (PCO) after
cataract surgery. SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS:
In a prospective study, 120 patients having cataract surgery were randomized to
implantation of a hydrophilic acrylic IOL (BL27, Bausch & Lomb) or a hydrophobic
acrylic IOL (AcrySof SA60AT, Alcon). Surgery was performed according to a
standardized protocol by 1 of 3 surgeons. Best corrected visual acuity, contrast
sensitivity, glare, intraocular pressure, and flare were measured 1 week, 3
months, and 1 year after surgery. Posterior capsule opacification was assessed
by digital retroillumination photography and analysis using POCOman software at
1 year. The rate of neodymium:YAG (Nd:YAG) capsulotomy for each IOL was also
recorded. RESULTS: At 1 year, the hydrophilic acrylic IOL group had a
significantly greater percentage area and severity of PCO than the hydrophobic
acrylic IOL group (P<.001). Two patients in the hydrophilic acrylic IOL group
and 4 in the hydrophobic acrylic IOL group had an Nd:YAG capsulotomy within the
first year (P>.05). Contrast sensitivity was significantly better in the
hydrophilic acrylic group at 3 months (P<.05); however, at 12 months no
difference between the IOLs was observed. There was no significant difference in
the other measured parameters. CONCLUSION: Patients with the hydrophilic acrylic
BL27 IOL had a significantly greater percentage area and severity of PCO than
those with the hydrophobic acrylic SA60AT IOL 1 year after surgery.
-----
Saudi Med J. 2006 Sep;27(9):1296-301.
A Cochrane Systematic Review finds no significant difference in
outcome or risk of postoperative complications between day care and in-patient
cataract surgery.
Fedorowicz Z, Lawrence DJ, Gutierrez P.
UK Cochrane Centre, UK. zbysfedo@batelco.com.bh
This review was conducted to determine reliable evidence regarding the safety,
feasibility, effectiveness, and cost-effectiveness of cataract extraction
performed as a day care versus in-patient procedure. The search to identify
randomized controlled trials comparing day care and in-patient surgery for
age-related cataract included the Cochrane Eyes and Vision Group Trials
Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE
and LILACS Latin American and Caribbean Literature on Health Sciences.
Assessment of methodological quality was based on criteria defined by the
Cochrane Collaboration. The primary outcome was the achievement of a
satisfactory visual acuity 6 weeks after operation. Two trials, involving a
total of 1284 people, are included. One trial reported statistically significant
differences in early postoperative complication rates in the day care group,
which had no clinical relevance to visual outcomes 4 months postoperatively.
Mean change in visual acuity Snellen lines of the operated eye 4 months
postoperatively was 4.1 standard deviation SD 2.3 for the day care group and 4.1
SD 2.2 for the in-patient group. Costs were 20% more for the in-patient group
attributable to higher costs for overnight stay.
-----
J Cataract Refract Surg. 2006 Sep;32(9):1513-20.
Effect of anterior capsule polishing on the posterior capsule
opacification-inhibiting properties of a sharp-edged, 3-piece, silicone
intraocular lens: three- and 5-year results of a randomized trial.
Bolz M, Menapace R, Findl O, Sacu S, Buehl W, Wirtitsch M, Leydolt C, Kriechbaum
K.
Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
PURPOSE: To evaluate the long-term effects of anterior capsule polishing on
regeneratory posterior capsule opacification (PCO), anterior capsule
opacification (ACO), and fibrotic PCO with a silicone intraocular lens (IOL)
with sharp optic edges. SETTING: Department of Ophthalmology, Medical University
of Vienna, Vienna, Austria. METHODS: This prospective bilateral randomized
patient- and examiner-masked clinical trial comprised 130 eyes of 65 patients
with bilateral age-related cataract. All eyes had implantation of a 3-piece
silicone IOL with a truncated, sharp-edged optic (CeeOn Edge 911A, Advanced
Medical Optics). In 1 eye, the anterior capsule was extensively polished using
an aspiration curette after phacoemulsification and cortex aspiration.
Regenerative PCO was quantified objectively, while ACO and fibrotic PCO were
graded subjectively 1, 2, 3, and 5 years postoperatively. RESULTS: The mean ACO
score was significantly lower in the eyes in which the anterior capsule had been
polished (1 year, P<.02; 2 years, P<.03; 3 years, P<.01; 5 years, P<.01). The
mean difference in regeneratory PCO and fibrotic PCO scores between the 2 groups
was not statistically significant. CONCLUSIONS: Three years after cataract
surgery, eyes in which the anterior capsule had been polished had significantly
less ACO. However, polishing did not lower PCO intensity when a sharp-edged
CeeOn 911A IOL was implanted in the bag. Although results indicate that anterior
capsule polishing may enhance the development of regeneratory PCO, this trend
did not reach statistical significance.
-----
Ophthalmology. 2006 Aug 24; [Epub ahead of print]
Cataract Surgery and the 10-Year Incidence of Age-Related
Maculopathy The Blue Mountains Eye Study.
Cugati S, Mitchell P, Rochtchina E, Tan AG, Smith W, Wang JJ.
Centre for Vision Research, Department of Ophthalmology and the Westmead
Millennium Institute, University of Sydney, Sydney, Australia.
PURPOSE: To assess the long-term (10-year) risk of late age-related maculopathy
(ARM) in eyes that had previously undergone cataract surgery (before the
baseline examination). DESIGN: Population-based cohort study. PARTICIPANTS: In
the Blue Mountains Eye Study (BMES) cohort, 2335 of 3654 baseline participants
>/=49 years old (75% of survivors) were reexamined after 5 years and 1952 (76%
of survivors) were reexamined after 10 years. METHODS: At the baseline
examination, nonphakic (aphakic or pseudophakic) eyes were identified at
slit-lamp examination and confirmed at lens photographic grading. Side-by-side
grading of baseline and follow-up stereoretinal photographs was performed using
the Wisconsin ARM grading system. Eye-specific data were analyzed using
Kaplan-Meier estimates and generalized estimating equation models, adjusting for
correlation between the 2 eyes. MAIN OUTCOME MEASURES: Incident late ARM was
defined if either neovascular ARM or geographic atrophy developed in eyes
without either lesion at baseline. RESULTS: After excluding eyes with either
late ARM lesion at baseline or that had missing photographs at either
examination, 4763 eyes were considered at risk of incident late ARM, including
132 eyes that had cataract surgery before the baseline examination. Late ARM
developed in 10 of 132 nonphakic eyes (7.6%) compared to 96 of 4631 phakic eyes
(2.1%). After adjusting for baseline age, gender, smoking, and presence of early
ARM lesions, nonphakic (cataract surgical) eyes had a 3-fold risk of developing
late-stage ARM (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.1-9.9) or
neovascular ARM (OR, 3.4; 95% CI, 1.1-10.9) compared to phakic eyes.
CONCLUSIONS: Our findings support the hypothesis that the long-term risk of
developing late ARM is higher in cataract surgical eyes, consistent with
findings from the Beaver Dam Eye Study.
-----
Cochrane Database Syst Rev. 2006 Jul 19;3:CD003171.
Surgical interventions for bilateral congenital cataract.
Long V, Chen S, Hatt S.
BACKGROUND: Congenital cataracts are opacities of the lens in one or both eyes
of children that cause a reduction in vision severe enough to require surgery.
Cataract is the largest treatable cause of visual loss in childhood. Paediatric
cataracts provide different challenges to those in adults. Intense inflammation,
amblyopia and posterior capsule opacification can affect results of treatment.
Two treatments commonly considered for congenital cataract are lensectomy and
lens aspiration. OBJECTIVES: The objective of this review was to assess the
effects of surgical treatments for bilateral symmetrical congenital cataracts.
Success was measured according to the vision attained and occurrence of adverse
events. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled
Trials (CENTRAL) on The Cochane Library, which contains the Cochrane Eyes and
Vision Group Trials Register (2005, Issue 2), MEDLINE (1966 to June 2005),
EMBASE (1980 to June 2005, week 27), LILACS (6 July 2005), the Science Citation
Index and the reference list of the included studies. We also contacted trial
investigators and experts in the field for details of further studies. SELECTION
CRITERIA: We included all prospective, randomised controlled trials that
compared one type of cataract surgery to another, or to no surgery, in children
with bilateral congenital cataracts aged 15 years or younger. DATA COLLECTION
AND ANALYSIS: Two authors extracted data. No meta-analysis was performed. MAIN
RESULTS: Four trials met the inclusion criteria. All trials were concerned with
reducing the development of visual axis opacification (VAO). This was achieved
with techniques that included an anterior vitrectomy or optic capture. Posterior
capsulotomy alone was inadequate except in older children. AUTHORS' CONCLUSIONS:
Evidence exists for the care of children with congenital or developmental
bilateral cataracts to reduce the occurrence of visual axis opacification.
Further randomised trials are required to inform modern practice about other
concerns including the timing of surgery, age for implantation of an intraocular
lens and development of long-term complications such as glaucoma and retinal
detachment.
-----
Klin Monatsbl Augenheilkd. 2006 Jul;223(7):559-67.
[Pharmacological means to prevent secondary cataract.]
[Article in German]
Rabsilber TM, Auffarth GU.
Univ.-Augenklinik, Ruprecht-Karls-Universitat Heidelberg.
Secondary cataract or posterior capsule opacification (PCO) is still the most
frequent long-term complication of cataract surgery. Tremendous advances have
been made, especially during the last 10 to 15 years, in terms of surgical
techniques and improvement of implant technology. However, the problem of
proliferation and migration of lens epithelial cells (LECs) postoperatively has
not yet been solved completely although we know that a sharp optic edge of
intraocular lenses (IOL) combined with hydrodissection, complete overlapping of
capsulorhexis and IOL-optic as well as capsular bending reduce PCO formation
significantly. In the 1980 s, investigators like Hartmann et al. began with the
application of pharmacological substances in-vitro in order to successfully
prevent LECs from proliferating and migrating. Cytostatic drugs, steroids,
non-steroidal antiphlogistics, adhesion inhibitors, heparin, lidocaine, suramin,
immunotoxins, photodynamic therapy and osmotic effective solutions were tested.
In several studies different drug delivery systems were investigated in order to
provide a longer and more effective impact on LECs. However, the in-vivo use has
been viewed critically since the selective targeting of LECs was not possible
and serious damage to the surrounding tissue had to be considered. Recently, the
development of the PerfectCapsule System for vacuum-sealed capsule irrigation
allows the selective targeting of LECs inside the capsular bag. This survey
gives an update on past, current and future means and trends to reduce or
prevent PCO formation pharmacologically.
-----
Br J Ophthalmol. 2006 Jul 19; [Epub ahead of print]
The international intravitreal bevacizumab safety survey: Using
the internet to assess drug safety worldwide.
Fung AE, Rosenfeld PJ, Reichel E.
Pacific Eye Associates, United States.
PURPOSE: Off-label intravitreal injections of bevacizumab (Avastin) have been
performed for the treatment of neovascular and exudative ocular diseases since
May 2005. Since then, the use of intravitreal bevacizumab has spread worldwide,
but the drug-related adverse events (AEs) associated with its use have only been
reported in a few retrospective reviews. The International Intravitreal
Bevacizumab Survey was initiated to gather timely information regarding adverse
events from physicians around the world via the internet. METHODS: An internet
based survey was designed to identify adverse events (AEs) associated with
intravitreal bevacizumab therapy. The survey web address was disseminated to the
international vitreoretinal community via email. Rates of AEs were calculated
from participant responses. RESULTS: Seventy centers from 12 countries reported
on 7,113 injections performed on 5,228 patients. Physician-reported AEs included
corneal abrasion, lens Injury, endophthalmitis, retinal detachment, inflammation
/ uveitis, cataract progression, acute vision loss, central retinal artery
occlusion, subretinal haemorrhage, retinal pigment epithelium tears, blood
pressure elevation, transient ischemic attack, cerebrovascular accident and
death. None of the AE rates exceeded 0.21%. CONCLUSION: Intravitreal bevacizumab
is being used globally for ocular diseases. Self-reporting of adverse events
following intravitreal bevacizumab injections did not reveal an increased rate
of potential drug-related ocular or systemic events. These short-term results
suggest that intravitreal bevacizumab appears safe.
-----
Br J Ophthalmol. 2006 Jul 6; [Epub ahead of print]
Bilateral cataract surgery and driving performance.
Wood JM, Carberry TP.
Queensland University of Technology, Australia.
BACKGROUND/AIMS: Cataract surgery is one of the most common medical procedures
undertaken world-wide. This study aimed to investigate whether cataract surgery
can improve driving performance and whether this can be predicted by changes in
visual function. METHODS: Twenty nine older participants with bilateral
cataracts and eighteen control participants with normal vision were tested. All
were licensed drivers. Driving and vision performance were measured prior to
cataract surgery and after second eye surgery for the cataract participants and
on two separate occasions for the controls. Driving performance was assessed on
a closed-road circuit. visual acuity, contrast sensitivity, glare sensitivity
and kinetic visual fields were measured at each test session. RESULTS: The
cataract participants had significantly poorer driving performance at the first
visit compared to the control participants for a range of measures of driving
performance, which significantly improved to the level of the control
participants following extraction of both cataracts. The change in contrast
sensitivity following surgery was the best predictor of the improvements in
driving performance in the cataract participants. CONCLUSIONS: Cataract surgery
results in significant improvements in driving performance and these
improvements are related to concurrent improvements in contrast sensitivity.
-----
Eye. 2006 Jun 9; [Epub ahead of print]
Comparison of epilenticular IOL implantation vs technique of
anterior and primary posterior capsulorhexis with anterior vitrectomy in
paediatric cataract surgery.
Rastogi A, Monga S, Khurana C, Anand K.
Pediatric Ophthalmology Service, Guru Nanak Eye Centre, Maulana Azad Medical
College, New Delhi, India.
PurposeTo compare the functional outcome of epilenticular intraocular lens (IOL)
implantation vsthe technique of anterior continuous curvilinear capsulorhexis (ACCC),
posterior continuous curvilinear capsulorhexis (PCCC) with vitrectomy and
in-the-bag IOL implantation in paediatric cataract surgery.MethodsForty eyes of
33 children with developmental or traumatic cataract, whose mean age was 2-12
years, were randomly divided into two groups A and B. Group A patients underwent
epilenticular IOL implantation while in group B patients, ACCC, PCCC with
anterior vitrectomy with in-the-bag IOL implantation was performed. Equal number
of eyes (10 each) with developmental cataracts (subgroups A1 and B1) and
traumatic cataracts (subgroups A2 and B2) were allotted to both the groups.
Postoperative visual acuity, opacification of the visual axis, and possible
complications were observed and analysed.ResultsFour eyes in subgroup B2 had
fibrous or ruptured capsules, and were managed by epilenticular IOL implantation
technique. One eye in subgroup B2 developed central posterior capsular
opacification and hence required a secondary capsulotomy. All cases in group A
maintained a clear visual axis at the last follow-up. Minimal postoperative
inflammation was noticed in all groups, which subsided with anti-inflammatory
medication. At the last follow-up, all eyes in group A gained visual acuity
>/=6/18. Whereas in group B, visual acuity >/=6/18 was obtained in 85.7% cases
with the epilenticular IOL implantation technique and in 83.3% cases with ACCC
and PCCC with anterior vitrectomy technique.ConclusionEpilenticular IOL
implantation offers a safe and effective alternative for management of
paediatric cataract. In selected cases of traumatic cataract, it is the
preferred treatment modality.Eye advance online publication, 9 June 2006;
doi:10.1038/sj.eye.6702451.
-----
Ophthalmic Res. 2006 Jun 6;38(4):218-245 [Epub ahead of print]
Intravitreal Triamcinolone Acetonide: A Change in a Paradigm.
Jonas JB.
Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, Ruprecht
Karls University of Heidelberg, Heidelberg, Germany.
Background: Based on experimental studies and clinical observations by Robert
Machemer, Gholam Peyman and others, the vitreous cavity has increasingly been
used as a reservoir of drugs for the direct treatment of intraocular diseases.
Methods and Results: The most widely injected drug so far has been triamcinolone
acetonide for various intraocular neovascular and edematous diseases. Comparing
the various diseases with respect to effect and side effects of the treatment,
the best response in terms of gain in visual acuity has been achieved for
intraretinal edematous diseases such as diffuse diabetic macular edema, branch
retinal vein occlusion, central retinal vein occlusion, and pseudophakic cystoid
macular edema. In eyes with various types of noninfectious uveitis including
acute or chronic sympathetic ophthalmia and Adamantiadis-Behcet's disease,
visual acuity increased and the degree of intraocular inflammation decreased.
Some studies have suggested that intra- vitreal triamcinolone may be useful as
an angiostatic agent in eyes with iris neovascularization and proliferative
ischemic retinopathies. Intravitreal triamcinolone may possibly be helpful as
adjunct therapy for exudative age-related macular degeneration, particularly in
combination with photodynamic therapy. In eyes with chronic, therapy-resistant
ocular hypotony, intravitreal triamcinolone can induce an increase in
intraocular pressure and may stabilize the eye. The complications of
intravitreal triamcinolone therapy include secondary ocular hypertension in
about 40% of the eyes injected; medically uncontrollable high intraocular
pressure leading to antiglaucomatous surgery in about 1-2% of the eyes;
posterior subcapsular cataract and nuclear cataract leading to cataract surgery
in about 15-20% in elderly patients within 1 year after injection; postoperative
infectious endophthalmitis with a rate of about 1:1,000; noninfectious
endophthalmitis, perhaps due to a reaction to the solvent agent, and
pseudoendophthalmitis with triamcinolone acetonide crystals appearing in the
anterior chamber. Intravitreal triamcinolone injection can be combined with
other types of intraocular surgery including cataract surgery, particularly in
eyes with iris neovascularization. Cataract surgery performed some months after
the injection does not show a markedly elevated complication rate. The injection
may be repeated, if vision redecreases. In nonvitrectomized eyes, the duration
of the effect and side effects of a single intravitreal injection of
triamcinolone is about 6-9 months for a dosage of about 20 mg, and about 2-4
months for a dosage of 4 mg. It has remained unclear so far, whether and how to
remove the solvent agent. In the future, intravitreal triamcinolone may be
combined with other antiangiogenic drugs for the treatment of exudative
age-related macular degeneration or with neuroprotective drugs for treatment of
diabetic retinopathy. Conclusions: Despite an exponentially increasing number of
mostly case-series studies, the intravitreal injection of triamcinolone may
still be considered an experimental procedure until randomized studies have been
presented. Copyright (c) 2006 S. Karger AG, Basel.
-----
J Cataract Refract Surg. 2006 May;32(5):826-30.
Benefit to patients of bilateral same-day cataract extraction:
Randomized clinical study.
Lundstrom M, Albrecht S, Nilsson M, Astrom B.
Department of Ophthalmology, Blekinge Hospital, Karlskrona, Sweden.
mats.lundstrom@ltbleking.se
PURPOSE: To compare patients' self-assessed visual function after bilateral
surgery performed on the same day with visual function after surgery in 1 eye at
a time. SETTING: Department of Ophthalmology, Blekinge Hospital, Karlskrona,
Sweden. METHODS: Patients with bilateral cataract were assigned randomly to 2
groups, patients having bilateral surgery on the same day and patients with 2
surgeries done 2 months apart. Both groups were examined before and 2 months and
4 months after surgery. All patients completed the Catquest questionnaire at
each ophthalmic examination. RESULTS: Until both eyes were operated on, patients
having surgery in 1 eye had significantly more difficulties performing daily
life activities (P<.001) and a worse binocular contrast sensitivity (P<.01) than
patients who had bilateral surgery on the same day. Four months after surgery of
both eyes in both groups, there was no difference in visual function.
CONCLUSIONS: Bilateral cataract surgery on the same day allowed rapid
rehabilitation of the patient and helped avoid suboptimal visual function in
daily life while waiting for second-eye surgery. However, there was no extra
long-term benefit of self-assessed visual function compared with cataract
surgery in 1 eye at a time.
-----
J Cataract Refract Surg. 2006 May;32(5):789-94.
Prospective randomized controlled trial of the effect of
intracameral vancomycin and gentamicin on macular retinal thickness and visual
function following cataract surgery.
Ball JL, Barrett GD.
Sir Charles Gairdner Hospital, Perth, Western Australia. jamesball@doctors.org.uk
PURPOSE: To investigate whether the use of vancomycin (20 microg/mL) and
gentamicin (8 microg/mL) in the infusion fluid at the time of cataract surgery
increases the incidence of macular thickening as measured with optical coherence
tomography (OCT) following phacoemulsification. SETTING: A public teaching
hospital in Western Australia. METHODS: Fourty-one patients (50 eyes) with
cataracts between 50 and 85 years of age were randomized to receive no
antibiotics in the infusion fluid at the time of cataract surgery (control
group) or vancomycin (20 microg/mL) and gentamicin (8 microg/mL) in the infusion
fluid (antibiotic group). Optical coherence tomography measurements were
performed preoperatively and 1 day and 1 and 5 weeks postoperatively. A
significant increase in macular thickness (mean of the central 1.0 mm diameter)
on OCT was defined as 15 microm or greater. Five weeks postoperatively, the best
corrected Snellen acuity and Pelli-Robson contrast sensitivity were measured.
RESULTS: Twenty-five percent in the control group and 38% in the antibiotic
group had a significant increase in macular thickness measured on OCT 5 weeks
postoperatively (P = .34). The mean contrast sensitivity of patients with
increased macular thickness on OCT was 1.26, and in those with no change it was
1.43 (P = .001). CONCLUSIONS: The use of intracameral vancomycin (20 microg/mL)
and gentamicin (8 microg/mL) at the time of cataract surgery had no significant
effect on macular thickness or visual function postoperatively. Overall, 31% of
eyes showed an increase of 15 microm or greater in central retinal thickness.
These patients had significantly reduced contrast sensitivity.
-----
J AAPOS. 2006 Feb;10(1):30-6.
Is there a latent period for the surgical treatment of children
with dense bilateral congenital cataracts?
Lambert SR, Lynn MJ, Reeves R, Plager DA, Buckley EG, Wilson ME.
Emory Eye Center, Atlanta, Georgia.
Background: It generally is accepted that cataract surgery during the first 6
weeks of life is associated with the best visual outcomes for children with
dense unilateral congenital cataracts. The latent period for children with dense
bilateral congenital cataracts has not been clearly defined. Methods: The
best-corrected visual acuity (BCVA) at 4 to 6 years of age was collected
retrospectively on a series of 43 children with dense bilateral congenital
cataracts from 4 institutions. All of the children underwent a lensectomy,
posterior capsulotomy, and anterior vitrectomy at 36 weeks of age or younger.
Results: Cataract surgery was performed at a mean age of 11.5 weeks for the
better-seeing eye. BCVA was assessed when the children were a mean of 5.3 years
of age. The visual acuities of 26 (60%) were 20/40 or better, 12 (28%) were
20/50 to 20/80, and 5 (12%) were 20/100 or worse. There was a trend for worse
BCVA with increasing age at the time of surgery (r = 0.28, P = 0.07). We noted
that a BCVA of 20/100 or worse occurred only among eyes undergoing surgery when
infants were older than 10 weeks (</=10 weeks: 0/21 = 0% vs. >10 weeks: 5/22 =
23%, P = 0.049). Children with preoperative nystagmus had worse visual outcomes;
only 38% of children with preoperative nystagmus achieved a BCVA of 20/40 or
better compared with 74% of children without preoperative nystagmus (P = 0.03).
Conclusion: Previous reports have proposed that cataract surgery during the
first 5 to 8 weeks of life is associated with better visual outcomes in children
with dense bilateral congenital cataracts. Our results would suggest that good
visual outcomes can be achieved beyond this age, but the incidence of poor
visual outcomes increases if cataract surgery is delayed beyond 10 weeks of age.
The absence of preoperative nystagmus is a better predictor of a good visual
outcome than the age at surgery.
-----
Klin Monatsbl Augenheilkd. 2006 Feb;223(2):142-146.
[Functional Results after Intraocular Lens Implantation with or
without Blue Light Filter: An Intraindividual Comparison.]
[Article in German]
Mayer S, Wirbelauer C, Pham DT.
Klinik fur Augenheilkunde, Vivantes Klinikum Neukolln (Dir.: Prof. D. T. Pham),
Berlin.
BACKGROUND: The new generation of intraocular lenses (IOL) with an additional
blue light filter has a slight yellowish colour (compared to the IOLs with only
a UV filter) due to its different light transmitting properties. This could have
an effect on contrast sensitivity and subjective visual perception. PATIENTS AND
METHODS: In this intraindividual prospective comparative study including 14
cataract patients without further ocular pathology, a blue light filtering IOL
(SN60AT, Alcon) was implanted in one eye and 1 month later a conventional
single-piece IOL (SA60AT, Alcon) was fitted into the fellow eye. The visual
acuity and the clinical findings were assessed at one day and four weeks
post-operatively. Contrast sensitivity was tested under defined mesopic (6 cd/m(2))
and high mesopic (18,8 cd/m(2)) light conditions in the Ginsburg Box using the
Functional Acuity Contrast Test (F.A.C.T.). Furthermore, subjective differences
in the visual perception of both eyes were noted. RESULTS: The contrast
sensitivity testing 1 day and 1 month postoperatively, revealed no statistically
significant differences (P > 0,008) between both IOL types for all spatial
frequencies (1,5/3/6/12/18 cpd) and light levels. 13 patients (85 %) reported no
differences in the colour perception of both eyes, and none had visual
disturbances. CONCLUSION: This intraindividual comparison revealed no relevant
differences concerning mesopic contrast sensitivity and the subjective visual
perception after implantation of one IOL with or without a blue light filter.
-----
J Fr Ophtalmol. 2006 Feb;29(2):157-63.
[Quality of vision after cataract surgery in patients with
prolate aspherical lens.]
[Article in French]
Denoyer A, Roger F, Majzoub S, Pisella PJ.
Service d'Ophtalmologie, Centre Hospitalo-Universitaire Bretonneau, Tours.
PURPOSE: To assess the quality of vision in pseudophakic patients with a prolate
aspherical intraocular lens (IOL) compared to patients with a spherical IOL.
PATIENTS AND METHODS: Twenty patients undergoing cataract surgery were divided
into two groups according to the type of IOL: ten prolate aspherical IOLs (TECNIS
Z9000, AMO, USA) and ten spherical IOLs (911 CeeOn Edge, AMO, USA). The
integrity of ocular functions was assessed with clinical examination and
multifocal electroretinogram. Contrast sensitivities were tested preoperatively
in photopic, mesopic, and glared conditions. Postoperative examinations included
refractive evaluation before and after mydriasis, pupil diameter, contrast
sensitivities, and wavefront aberration analysis. RESULTS: Postoperative
best-corrected visual acuity was 0.95 +/- 0.13 for the TECNIS group vs 0.98 +/-
0.11 for the 911 group (p=0.32). Refractive evaluation revealed mydriasis myopic
shift in patients with the 911 IOL (- 0.10+/-0.30 D for the TECNIS group vs -
0.68+/-0.21 D for the 911 group, p=0.002). Mesopic contrast sensitivity was
improved in the TECNIS group regarding medium and high spatial frequencies
(p=0.003 and p=0.002, respectively), whereas photopic and glared contrast
sensitivities were equal in both groups. RMS for high-order aberrations was 0.36
+/- 0.07 microm in the TECNIS group vs 0.33 +/- 0.19 microm in the 911 group
(p=0.21), and spherical aberration was lower in patients with TECNIS IOL
(Z40=0.03+/-0.06 microm vs 0.20+/-0.14 microm, for the TECNIS group and the 911
group, respectively, p=0.029). CONCLUSION: Combining contrast sensitivities and
wavefront aberration analysis provided an objective assessment of the quality of
vision in pseudophakic patients. Using prolate aspherical IOL could reduce
spherical aberration and improve visual acuity, especially in mesopic
conditions.
-----
Eur J Ophthalmol. 2006 Jan-Feb;16(1):33-9.
Accommodative intraocular lenses: Short-term visual results of
two different lens types.
Buratto L, Di Meglio G.
Centro Ambrosiano di Microchirurgia Oculare, Milano - Italy.
PURPOSE. To compare the ability of two types of accommodative intraocular lenses
(IOLs) to provide uncorrected near and distance visual acuity (VA) after
cataract surgery. METHODS. A total of 108 eyes of 75 patients underwent cataract
surgery by phacoemulsification and IOL implantation either bilaterally or
monocularly with one of two types of accommodative IOLs: the AT-45 lens (69
eyes) or the 1-CU lens (39 eyes). Patients were followed for up to 1 year after
cataract surgery. Near VA was measured through the distance correction to obtain
the true near vision effect of the accommodating IOL. RESULTS. Uncorrected
distance VA of 20/30 or better was achieved by 84.6% of the bilaterally
implanted 1-CU patients and 73.6% of the bilaterally implanted AT-45 IOL
patients 1 year following surgery. Uncorrected near VA of J1 or better was
achieved by 42% of the patients with the bilateral 1-CU implant and 36.8% of the
patients with the bilateral AT-45 implant. For J3 or better near acuity, the
values were 92.3% for the bilateral 1-CU patients and 84.2% for the bilateral
AT-45 patients at 1 year. A total of 54% of the eyes with 1-CU implants
underwent a mild myopic shift (<1.0 D), 21% had a mild hyperopic shift, and 45%
of the eyes were emmetropic at 1 year. CONCLUSIONS. Both accommodative IOLs
provided good near and distance vision postoperatively. The 1-CU IOL appears
clinically to provide slightly better uncorrected distance and
distance-corrected near VA than the AT-45 lens. (Eur J Ophthalmol 2006; 15:
33-39).
-----
J Cataract Refract Surg. 2006 Jan;32(1):85-90.
Phacoemulsification and intraocular lens implantation for acute
angle closure not treated or previously treated by laser iridotomy.
Imaizumi M, Takaki Y, Yamashita H.
>From the Department of Ophthalmology (Imaizumi, Takaki), Oita University
Faculty of Medicine, and the Department of Ophthalmology (Imaizumi, Yamashita),
Oita Prefectural Hospital, Oita, Japan.
PURPOSE: To determine the effect of phacoemulsification, aspiration, and
intraocular lens (IOL) implantation in eyes with acute angle closure or eyes
with prior laser iridotomy for acute angle closure. SETTING: Department of
Ophthalmology, Oita Prefectural Hospital, Oita, Japan. METHODS: Eighteen eyes
with acute angle closure and 8 eyes with cataracts that had a prior acute angle
closure treated by laser iridotomy had phacoemulsification, aspiration, and IOL.
A third group that had phacoemulsification, aspiration, and IOL for cataracts
only served as controls. The preoperative and postoperative intraocular
pressures (IOPs), visual acuities, and number of antiglaucoma medications were
compared between these 3 groups. RESULTS: The mean IOPs in the eyes with
phacoemulsification, aspiration, and IOL alone and the eyes with prior acute
angle closure treated by laser iridotomy were decreased significantly after
phacoemulsification, aspiration, and IOL. The mean IOPs in the control group
also decreased, but not significantly. There was no significant difference in
the postoperative IOP between the 3 groups. The postoperative visual acuities
were improved significantly in the 3 groups, and the differences in the final
visual acuities were not significant. Postoperatively, the antiglaucoma
medication was not needed in the phacoemulsification, aspiration, and IOL-alone
group, but medication was necessary in eyes treated previously with laser
iridotomy. CONCLUSION: Phacoemulsification with IOL implantation lowered IOP,
improved visual acuity, and diminished the need for antiglaucoma medication in
eyes with acute angle closure and with a prior acute angle closure treated by
laser iridotomy.
-----
J Cataract Refract Surg. 2006 Jan;32(1):60-66.
Recovery of visual and functional disability following cataract
surgery in older people: Sunderland Cataract Study.
Gray CS, Karimova G, Hildreth AJ, Crabtree L, Allen D, O'connell JE.
>From the School of Clinical Medical Sciences (Gray, Crabtree, O'Connell),
University of Newcastle upon Tyne, Newcastle upon Tyne, Research and Development
Department (Karimova, Hildreth), Sunderland Royal Hospital, and Sunderland
Cataract Centre (Allen), Sunderland, United Kingdom.
PURPOSE: To examine changes in visual, psychological, and functional disability
in older people waiting for cataract extraction and 6 months after surgery.
SETTING: Community-based study in Northeast England. METHODS: Participants were
92 patients (mean age 78.1 years +/- 6.5 [SD], 79% female) with age-related
cataract. Questionnaires were administered at time of listing for cataract
extraction, 2 weeks preoperatively, and 2 and 6 months after surgery to assess
visual symptoms and function, anxiety and depression, perceived health status,
cognition, and activities of daily living. RESULTS: Mean waiting time was 265
+/- 64.4 days. Forty-six patients had first-eye surgery, 39 had second-eye
surgery, and 7 had sequential-eye surgery (both eyes operated on during
follow-up). During the waiting period, there were no significant changes in
visual symptoms, cognition, or functional abilities. However, perceived health
status, anxiety, and depression improved significantly during this time. For
first- and second-eye patients, surgery resulted in significant improvements in
all questionnaire scores, except activities of daily living. CONCLUSIONS:
Despite waiting 9 months for cataract surgery, patients did not decline in
visual symptoms, social functioning, or cognition. In first- and second-eye
patients, successful cataract extraction resulted in significant gains in visual
function, cognition, and emotional and general well-being. The benefits of
cataract surgery in older people extended beyond simple measures of visual
acuity.
-----
J Cataract Refract Surg. 2005 Dec;31(12):2329-33.
Results of cataract extraction after implantable contact lens
removal.
Bleckmann H, Keuch RJ.
Augenzentrum DRK Kliniken Westend, Affiliated Hospital of the Humbold University
Berlin, Berlin, Germany. prof.dr.h.bleckmann@t-online.de
PURPOSE: To evaluate the visual results following insertion of implantable
contact lenses (ICLs) in ametropic eyes and the development of subcapsular
opacification with visual loss and to examine the anterior capsule, including
the subcapsular tissue alteration, by light microscopy. SETTING: Department of
Ophthalmology, Schlosspark-Klinik, affiliated hospital of the Charite Berlin,
Humbold University, Berlin, Germany. METHODS: A prospective noncomparative
interventional case series of anterior subcapsular cataracts in 9 of 127 (7.1%)
patient eyes receiving ICLs to correct myopia and hyperopia was studied. The
cataracts were phacoemulsified due to visual loss, and an intraocular lens (IOL)
was implanted in the bag. After capsulorhexis, the anterior capsule was
withdrawn for light microscopy examination. Visual acuity in each eye was
measured before and after ICL implantation and before and after cataract
extraction. The age range of cataract patients was 39 to 53 years. RESULTS:
Implantable contact lens removal and phacoemulsification with IOL implantation
for emmetropia resulted in an increased visual acuity compared to initial
vision. Four of 28 hyperopic eyes (14.3%) developed subcapsular central
opacification after ICL implantation, whereas 5 of 99 myopic patients (5.1%)
developed opacifications. CONCLUSIONS: Patients should be informed prior to ICL
implantation, there is a possibility of secondary subcapsular cataract formation
and vision reduction. Although the posterior chamber inlay as well as the
cataract can be removed and better acuity can be restored, a possible
complication due to the ICL implantation cannot be avoided and the accommodation
in young patients lost.
-----
J Cataract Refract Surg. 2005 Dec;31(12):2319-23.
Clinical results of the blue-light filtering AcrySof Natural
foldable acrylic intraocular lens.
Marshall J, Cionni RJ, Davison J, Ernest P, Lehmann R, Maxwell WA, Solomon K.
Department of Ophthalmology GKT, the Rayne Institute, St. Thomas' Hospital,
London, England. june.spacey@kcl.ac.uk
PURPOSE: To verify the safety and effectiveness of the new AcrySof Natural (Alcon
Laboratories, Inc.) blue-light filtering intraocular lens (IOL), which was
designed to achieve a light-transmission spectrum similar to that of the natural
human crystalline lens. SETTING: Multicenter U.S. clinical trial. METHODS: In a
prospective randomized patient-masked multicenter study, 150 patients received
the AcrySof Natural IOL and 147 patients received the AcrySof single-piece IOL
as a control. Patients with bilateral age-related cataracts who were willing and
able to wait at least 30 days between cataract procedures and had verified
normal preoperative color vision were eligible for the study. Standardized
surgery included a 4.0 to 5.0 mm capsulorhexis and phacoemulsification. All
lenses were inserted in the capsular bag, with verification of in-the-bag
placement of both haptics. In all bilateral implantation cases, the same model
IOL was used in each eye. Postoperatively, contrast sensitivity and color
perception were measured up to 180 days and up to 1 year (for visual acuity)
after implantation. RESULTS: No statistically significant differences were
discovered between the 2 patient groups in visual acuity, contrast sensitivity
evaluated under mesopic and photopic conditions, or the number of patients who
passed the Farnsworth D-15 color perception test. There were no lens-related
adverse events in either group. CONCLUSIONS: The blue-light filtering AcrySof
Natural IOL was equivalent to the conventional AcrySof lens in terms of
postoperative visual performance. Additional long-term clinical studies should
show whether the IOL actually provides the theoretical benefits to retinal
health.
-----
Ophthalmologica. 2005 Nov-Dec;219(6):390-3.
A retrospective analysis of five intra-ocular lenses and the
predictive value of six different intra-ocular lens power calculation formulas.
Zuidervaart W, Luyten GP.
Department of Ophthalmology, University Medical Centre Leiden, Leiden, The
Netherlands.
Purpose: To evaluate the refractive and visual outcome after implantation of
five different lenses and to evaluate the accuracy of six different intra-ocular
lens (IOL) power formulas. Setting: Department of Ophthalmology, University
Medical Centre Rotterdam, The Netherlands. Methods: In total, 288 eyes had
cataract surgery with implantation of a polymethylmethacrylate lens (Centra55B)
or a foldable silicone lens (AMO SI40, Staar AA, Silens 5, Pliolens). The pre-
and postoperative refraction and visual outcome were analysed for all lenses
under study. Six different IOL power formulas have been used to compare the
accuracy of the predictive refractive outcome. Results: The Staar Plate Haptic
lens was found to have the best uncorrected visual acuity (UCVA) compared to the
Centra55B, AMO SI40 and the Pliolens. Based on the A constant given by the
company, the Pliolens revealed a significant overcorrection and the Staar Plate
Haptic lens an undercorrection. The achieved postoperative refraction minus the
intended postoperative refraction caused significant myopia with the Pliolens
and hyperopia with the Staar Plate Haptic lens. The SRK-T and the Holladay
formulas give the best predictive lens calculations in relation to the axial
length. Conclusion: The A constant of all lenses has to be adjusted for our
institute. Especially the AMO SI40, the Staar AA lens and the Silens 5 showed a
remarkable difference compared to the A constant given by the company. All
foldable lenses were comparable in their visual outcome. The significantly
better UCVA of the Staar Plate Haptic lens can be explained by the emmetropic
outcome of the postoperative refraction. Copyright (c) 2005 S. Karger AG, Basel.
-----
Ann Pharmacother. 2005 Dec;39(12):2065-71. Epub 2005 Nov 15.
Vitamin e supplementation in Alzheimer's disease, Parkinson's
disease, tardive dyskinesia, and cataract: part 2.
Pham DQ, Plakogiannis R.
1 Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island
University, Brooklyn, NY; Internal Medicine Pharmacotherapy Specialist, Kings
County Hospital Center, Brooklyn.
OBJECTIVE: To review clinical trials evaluating the safety and efficacy of
vitamin E supplementation in Alzheimer's disease, Parkinson's disease, tardive
dyskinesia, and cataract. DATA SOURCES: Using the MeSH terms alpha-tocopherol,
tocopherols, vitamin E, Parkinson disease, tardive dyskinesia, Alzheimer
disease, cataract, and clinical trials, a literature review was conducted to
identify peer-reviewed articles in MEDLINE (1966-July 2005). STUDY SELECTION AND
DATA EXTRACTION: Published materials including original research, review
articles, and meta-analyses were reviewed. Only English-language articles and
trials that included vitamin E alone or in combination with other vitamins or
minerals were reviewed. Emphasis was placed on prospective, randomized,
double-blind, placebo-controlled clinical trials. DATA SYNTHESIS: The clinical
studies demonstrated contradicting results regarding the benefits of vitamin E
in Parkinson's disease, tardive dyskinesia, and cataract. The study reviewed for
Alzheimer's disease seemed to show benefit when vitamin E was used; however, the
statistical methods employed are questionable. There is enough evidence from
large, well-designed studies to discourage the use of vitamin E in Parkinson's
disease, cataract, and Alzheimer's disease. We recommend that vitamin E be
considered a treatment option in patients with tardive dyskinesia only if they
are newly diagnosed. CONCLUSIONS: We encourage patients to supplement with
vitamin E-rich foods. The use of a daily multivitamin, which usually contains 30
IU of alpha-tocopherol, may be beneficial; however, we discourage individual
vitamin E supplements that usually contain 400 IU of alpha-tocopherol.
-----
Bull Soc Belge Ophtalmol. 2005;(297):45-57.
Surgical treatment outcomes of congenital and juvenile cataracts.
Casaer P, Casteels I, Foets B.
Department of Ophthalmology, St Rafael UZ, Leuven, Belgium.
PURPOSE: Evaluation of visual outcome after lens aspiration with or without
intraocular lens implantation for isolated congenital and juvenile cataract in
children aged 6 years and younger. MATERIAL AND METHODS: Retrospective review of
48 children with isolated congenital and juvenile cataract who were surgically
treated between January 1993 and December 2002 and had a minimal follow-up of 12
months. RESULTS: In the group of children with unilateral cataract, 33% (3 out
of 9 children) of aphakic children and 45.5% (5 out of 11 children) of
pseudophakic children attained a final best corrected visual acuity of 20/200
and 20/60 respectively. In the group of children with bilateral involvement, 35%
(6 out of 17 children) of aphakic children have a final best corrected visual
acuity of 20/30 and 63.7% (7 out of 11 children) of pseudophakic children have a
final best corrected visual acuity of 20/25 or more. CONCLUSION: The results of
this study emphasize the need for early surgery and good organisation of
postsurgical care in patients with pediatric cataract to optimise visual
outcome. Furthermore patients with isolated unilateral congenital cataract
surgically treated at an average age of 15 months without primary lens
implantation and with variable and low compliance have suboptimal results. The
effect of early surgery with primary lens implantation on the long term visual
outcome in pediatric cataract needs to be further evaluated.
-----
Eye. 2005 Nov 4; [Epub ahead of print]
Dexamethasone-netilmicin: a new ophthalmic steroid-antibiotic
combination. Efficacy and safety after cataract surgery.
Russo S, Papa V, Bella AD, Favero A, Radulescu C, Gafencu O, Carstocea B,
Milazzo G.
1Medical Department, SIFI S.p.A., Aci S.Antonio, Italy.
PurposeThe purpose of this study was to evaluate both efficacy and safety of a
new ophthalmic steroid-antibiotic fixed combination containing dexamethasone and
netilmicin in the postsurgical management of cataract surgery.MethodsIn total,
223 patients were randomly treated with dexamethasone 1 mg/ml plus netilmicin 3
mg/ml (n=148), or dexamethasone 1 mg/ml plus tobramycin 3 mg/ml (n=75,
TOBRADEX((R))) four times in a day for 7+/-1 days starting immediately after
surgery. Efficacy (anterior chamber (AC) inflammation, conjunctival hyperaemia,
corneal and lid oedema, ocular infection, pain, photophobia and tearing) and
safety (burning, stinging, blurred vision, intraocular pressure, and visual
acuity) were analysed in the operated eye after 1 and 7+/-1 days. A follow-up
visit was performed at day 14+/-2. The extent of AC inflammation, measured by
slit-lamp according to a standard scoring system, was used as primary efficacy
parameter.ResultsAt the primary end point (day 7) both fixed combinations were
equally effective in reducing postoperative inflammation. The safety profile of
the dexamethasone/netilmicin combination was excellent with no evidence of poor
local tolerance or adverse reaction.ConclusionsA new fixed combination of
dexamethasone and netilmicin was effective and safe in controlling ocular
inflammation after cataract surgery.Eye advance online publication, 4 November
2005; doi:10.1038/sj.eye.6702123.
-----
Br J Ophthalmol. 2005 Nov;89(11):1420-2.
Non-steroidal anti-inflammatory agents for cystoid macular oedema
following cataract surgery: a systematic review.
Sivaprasad S, Bunce C, Wormald R.
Moorfields Eye Hospital, 162 City Road, London EC1V 2PD, UK.
AIM: To examine the effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs)
in the treatment of cystoid macular oedema (CMO) following cataract surgery.
METHODS: Systematic literature review of randomised controlled trials (RCTs)
that evaluated the effects of NSAIDs in the treatment of CMO following cataract
surgery was done according to the Cochrane Collaboration methodology. RESULTS:
Seven trials involving a total of 266 participants were included. Four trials
studied the effects of NSAIDs in chronic CMO while the other three trials
examined the effect of NSAIDs in acute CMO. Little evidence of effectiveness was
found for oral indomethacin and topical fenoprofen for chronic CMO in two small
trials. Treatment with topical 0.5% ketorolac for chronic CMO was found to be
effective in two trials. Three trials examined the effect of topical NSAIDs on
acute CMO. The comparisons among these studies were of a NSAID to placebo,
prednisolone or another NSAID. Because of considerable heterogeneity between
these study designs, their results were not combined in a meta-analysis.
CONCLUSION: A positive effect of topical NSAID (0.5% ketorolac tromethamine
ophthalmic solution) on chronic CMO was noted. However, there is not enough
evidence to show the effectiveness of NSAIDs in acute CMO following cataract
surgery.
-----
Ophthalmology. 2005 Nov;112(11):1997-2003. Epub 2005 Sep 23.
Outcomes of microincision cataract surgery versus coaxial
phacoemulsification.
Alio J, Rodriguez-Prats JL, Galal A, Ramzy M.
Instituto Oftalmologico de Alicante, VISSUM Corp., and Ophthalmology Division,
Miguel Hernandez University, Alicante, Spain. jlalio@vissum.com
PURPOSE: To compare outcomes of microincision cataract surgery (MICS) with
coaxial phacoemulsification. DESIGN: Prospective randomized consecutive case
series. PARTICIPANTS: One hundred eyes of 50 patients with nuclear or
corticonuclear cataract (grades 2+ to 4) with Lens Opacities Classification
System III. METHODS: One hundred eyes (50 patients) were randomly operated
through clear corneal incisions using 2 techniques: coaxial phacoemulsification
(50 eyes) and microincision cataract surgery (50 eyes). MAIN OUTCOME MEASURES:
Mean phacoemulsification time, total phacoemulsification percent, effective
phacoemulsification time (EPT) (calculated by multiplying total
phacoemulsification time in seconds by the average power percent used),
intraoperative total balanced salt solution (BSS) volume, visual outcome,
vectorial astigmatic changes, corneal thickness, endothelial cell count, and
anterior chamber flare and cells preoperatively and at 1 day, 1 month, and 3
months. RESULTS: Statistically significant differences were found between MICS
and coaxial phacoemulsification regarding mean incision size, mean total
phacoemulsification percent, and EPT. There were no significant differences
between the techniques regarding the mean percent of endothelial cell loss,
anterior chamber cell count and flare, mean phacoemulsification time,
pachymetric measures or total BSS volume utilized, or visual outcome. The
vectorial astigmatic changes in the MICS group showed a change of < or =0.25
diopters (D) in 35% of the eyes, 0.25 to 0.5 D in 50% of the eyes, and 0.5 to
1.0 D in 15% of the eyes. These changes were induced by the surgery. Vectorial
astigmatic changes of >1 D were not observed. In the coaxial phacoemulsification
group, vectorial astigmatic changes of <0.25 D were not observed either. Changes
of 0.25 to 0.5 D were seen in 20% of the eyes, and changes of 0.5 to 1.0 D were
seen in 30%. Fifty percent of the eyes showed changes of >1.0 D. Mean vectorial
astigmatic changes were 0.36+/-0.23 D in the MICS group and 1.2+/-0.74 D in the
coaxial phacoemulsification group (P<0.001). CONCLUSIONS: Microincision cataract
surgery significantly lowered mean phacoemulsification time, mean total
phacoemulsification percent, mean EPT, and surgically induced astigmatism when
compared with coaxial phacoemulsification.
-----
Ophthalmology. 2005 Nov;112(11):1992-6. Epub 2005 Sep 23.
Aqueous penetration and biological activity of moxifloxacin 0.5%
ophthalmic solution and gatifloxacin 0.3% solution in cataract surgery patients.
Kim DH, Stark WJ, O'Brien TP, Dick JD.
Anterior Segment and Cataract/Refractive Service, The Wilmer Eye Institute,
Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-9238,
USA.
PURPOSE: To measure the achievable perioperative aqueous concentration of the
commercially available topically administered fourth generation fluoroquinolones,
moxifloxacin 0.5% ophthalmic solution, and gatifloxacin 0.3% ophthalmic
solution, and to correlate this concentration with the agents' biological
efficacy in the aqueous humor of patients undergoing routine cataract surgery.
DESIGN: Prospective, randomized, parallel, double-masked, clinical trial.
PARTICIPANTS: Fifty patients undergoing cataract extraction. METHODS: Patients
(n = 25) were given perioperative topical moxifloxacin 0.5% or topical
gatifloxacin 0.3% (n = 25). One drop of antibiotic was administered every 10
minutes for 4 doses beginning 1 hour prior to surgery. Aqueous humor was sampled
via paracentesis and antibiotic concentrations were determined using validated
high performance liquid chromatography (HPLC) procedures. Dilution analyses were
performed to determine the biological efficacy of the agents in the aqueous
against Staphylococcus epidermidis, the most common cause of postcataract
endophthalmitis. MAIN OUTCOME MEASURES: Aqueous humor antibiotic concentrations
were measured using HPLC and microdilution bioassay techniques. Biological
activity was measured as minimal inhibitory dilution and minimal bactericidal
dilution. RESULTS: Aqueous humor concentrations for moxifloxacin via HPLC
analysis were 1.80 (+/-1.21) microg/ml, whereas those for gatifloxacin were 0.48
(+/-0.34) microg/ml. This 3.8-fold difference in aqueous humor antibiotic
concentrations was statistically significant (P = 0.00003). Similarly, the
biological dilution analysis of the aqueous humor samples showed that
moxifloxacin attained an estimated activity of 2.1 microg/ml, whereas the
gatifloxacin activity was approximately 0.4 mug/ml, which represented a 4.9-fold
difference. CONCLUSIONS: This study demonstrated that after topically
administered perioperative antibiotics with cataract surgery, moxifloxacin 0.5%
ophthalmic solution achieved a statistically significantly higher concentration
in aqueous humor compared with gatifloxacin (P = 0.00003). Results from the
broth dilution analysis showed that moxifloxacin 0.5% was biologically more
active against S. epidermidis than gatifloxacin 0.3% in aqueous humor after
topical application. There were no adverse events reported, and incision wounds
healed quickly and as expected.
-----
Clinics. 2005 Oct;60(5):401-6. Epub 2005 Oct 24.
Second eye cataract surgery: perceptions of a population assisted
at a university hospital.
Avakian A, Temporini ER, Kara-Jose N.
Discipline of Ophthalmology, Hospital das Clinicas, Faculty of Medicine,
University of Sao Paulo, Brazil. aavakian@uol.com.br
OBJECTIVE: To identify daily life difficulties perceived by patients suffering
from senile cataract before and after second eye cataract surgery. METHODS:
Longitudinal prospective study with 84 patients consecutively seen within the
framework of the Cataract Project, with visual acuity equal to or higher than
20/30 in the pseudophakic eye, and equal to or lower than 20/40 with the best
possible optical correction in the cataractous eye. A questionnaire was applied
during an interview. RESULTS: Before surgery, 60.7% complained about visual
impairment (moderate or marked); after surgery, 92.8% had no difficulty. Routine
activities, mobility, and leisure activities were significantly altered after
surgery (P =.001). CONCLUSION: According to the patients' perceptions, there was
a significant reduction in visual difficulties after second eye cataract
surgery.
-----
J Public Health (Oxf). 2005 Oct 18; [Epub ahead of print]
Comparing outcomes of cataract surgery: challenges and
opportunities.
McKee M, Whatling JM, Wilson JL, Vallance-Owen A.
London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT,
UK.
BACKGROUND: There is an increasing demand for routine assessment of surgical
outcomes. However, for assessments to be valid, it is essential to understand
the influence of patient characteristics on outcomes. The VF-14 visual function
instrument offers a possible means of monitoring outcomes of cataract surgery.
This article examines lessons learned in the course of an attempt to do this.
METHODS: One thousand and ninety-eight patients (41 per cent male and 59 per
cent female) undergoing cataract extraction in 29 private hospitals within the
British United Provident Association (BUPA) chain in the United Kingdom
completed the VF-14 before and at 4 months following surgery. Outcome was
measured in terms of absolute post-operative score achieved. The demographic
factors associated with post-operative VF-14 score were examined using
multivariate analysis, adjusting for baseline score. RESULTS: Women undergoing
cataract extraction had worse pre-operative visual function than men.
Post-operative VF-14 score was stable as the age of the patient increased, until
age 85, after which it declined. The reduction in final outcome in older people
was explained in part by their worse post-operative scores but also was
associated with increasing age independent of pre-operative score. CONCLUSION:
First, although many patients undergoing cataract extraction at an advanced age
will achieve excellent results, older age does reduce the outcome that can be
expected. Consequently, comparisons of performance of units or surgeons
undertaking cataract surgery must take account of the age spectrum being
treated. It is not enough simply to add a health status measure to an existing
administrative database. Further research is needed to understand the reasons
for the poorer outcomes at older ages, in particular the role of co-existing eye
disease and development of data systems must take account of the additional
information required to make appropriate adjustments.
-----
Acta Ophthalmol Scand. 2005 Oct;83(5):561-6.
Phacoemulsification in trabeculectomized eyes.
Ehrnrooth P, Lehto I, Puska P, Laatikainen L.
Department of Ophthalmology, University of Helsinki, Helsinki, Finland.
pia.ehrnrooth@sci.fi
PURPOSE: To evaluate retrospectively risk indicators for cataract surgery and
the effect of phacoemulsification on intraocular pressure (IOP) control in eyes
that have undergone trabeculectomy. METHODS: We undertook a retrospective
analysis of 138 eyes with primary open-angle glaucoma (POAG) or exfoliation
glaucoma (EG) in 138 consecutive patients over the age of 40 years undergoing
trabeculectomy with no antimetabolites performed by one surgeon. Of the 48 eyes
(35%) undergoing a cataract operation during the follow-up period of 2-5 years,
46 were included in this analysis. Their IOP, glaucoma medication and best
corrected visual acuity (BCVA) before cataract surgery and at the last follow-up
were compared. Risk indicators for cataract surgery were analysed. RESULTS:
Cataract operations were performed 5.1-58.1 months (median 14.4 months) after
trabeculectomy. The mean length of follow-up after cataract surgery was 25.3
months (SD 12.9, median 24.8 months). Before cataract surgery, the mean IOP was
16.2 mmHg (SD 4.9) and the mean number of topical antiglaucoma medicines 0.8 (SD
1.0). At the most recent visit, mean IOP was 17.3 mmHg (SD 6.4) (p = 0.35), and
the mean number of medicines was 1.3 (SD 1.1) (p = 0.0007). Of the 22 eyes in
which treatment had been categorized as completely successful (IOP < or = 21
mmHg without other therapy) before cataract surgery, 13 (59%) had remained so.
The number of failures (IOP > 21 mmHg, or more than one medication needed or
further surgery performed) increased from 14 (30%) before surgery to 28 (61%)
afterwards. The proportion of failures in the cataract surgery group was twice
that in the no cataract surgery group (61% versus 31%). In a proportional
hazards regression, only age (73.9 years [SD 9.4] and 68.1 years [SD 9.8] in
patients with and without cataract surgery, respectively) proved to be a
significant (p = 0.001) indicator for surgery. CONCLUSION: The results of this
retrospective study on consecutive clinical cases of trabeculectomy indicate
that cataract progression after trabeculectomy is mainly an age-related process.
In more than half the eyes with good preoperative IOP control, this good control
was maintained after cataract surgery. On the other hand, in some eyes cataract
surgery may compromise IOP control even when surgery avoids the area of the
bleb.
-----
Prog Retin Eye Res. 2005 Sep;24(5):587-611. Epub 2005 Mar 29.
Intravitreal triamcinolone acetonide for treatment of intraocular
proliferative, exudative, and neovascular diseases.
Jonas JB, Kreissig I, Degenring R.
Department of Ophthalmology, Faculty of Clinical Medicine Mannheim,
Ruprecht-Karls-University of Heidelberg, Germany. jost.jonas@augen.ma.uni-heidelberg.de
Within the last three years, triamcinolone acetonide has increasingly been
applied intravitreally as treatment option for various intraocular neovascular
edematous and proliferative disorders. The best response in terms of gain in
visual acuity after the intravitreal injection of triamcinolone acetonide was
found in eyes with intraretinal edematous diseases such as diffuse diabetic
macular edema, branch retinal vein occlusion, central retinal vein occlusion,
and pseudophakic cystoid macular edema. Visual acuity increased and degree of
intraocular inflammation decreased in eyes with various types of non-infectious
uveitis including acute or chronic sympathetic ophthalmia and
Adamantiadis-Behcet's disease. Intravitreal triamcinolone may be useful as
angiostatic therapy in eyes with iris neovascularization and proliferative
ischemic retinopathies. Possibly, intravitreal triamcinolone may be helpful as
adjunct therapy for exudative age-related macular degeneration, possibly in
combination with photodynamic therapy. In eyes with chronic, therapy resistant,
ocular hypotony, intravitreal triamcinolone can induce an increase in
intraocular pressure and may stabilize the eye. The complications of
intravitreal triamcinolone therapy include secondary ocular hypertension in
about 40% of the eyes injected, cataractogenesis, postoperative infectious and
non-infectious endophthalmitis, and pseudo-endophthalmitis. Intravitreal
triamcinolone injection can be combined with other intraocular surgeries
including cataract surgery. Cataract surgery performed some months after the
injection does not show a markedly elevated rate of complications. If vision
increases and eventually decreases again after an intravitreal triamcinolone
acetonide injection, the injection can be repeated. The duration of the effect
of a single intravitreal injection of triamcinolone depended on the dosage
given. Given in a dosage of about 20mg to non-vitrectomized eyes, the duration
of the effect and of the side-effects was 6-9 months. Intravitreal triamcinolone
acetonide may offer a possibility for adjunctive treatment of intraocular
edematous and neovascular disorders. One has to take into account the
side-effects and the lack of long-term follow-up observations.
-----
Ophthalmologe. 2005 Aug 24; [Epub ahead of print]
[Cataract extraction including posterior chamber lens
implantation into eyes with angle-closure glaucoma.]
[Article in German]
Bleckmann H, Keuch R.
Augenzentrum des DRK-Klinikums Westend, Akademisches Lehrkrankenhaus der
Humbold-Universitat, Berlin.
OBJECTIVE: The aim of this study was to compare phacoemulsification in eyes with
angle-closure glaucoma to the partner eyes with or without iridectomy or laser
iridotomy, respectively.METHODS: Twelve eyes with an elevated intraocular
pressure due to an angle closure that were treated by phacoemulsification and
IOL implantation were compared with 12 partner eyes with narrow angle and
iridectomy or iridotomy without intraocular pressure elevation and cataract
extraction. The average follow-up period was 15.7+/-2.1 months.RESULTS: The
average intraocular pressure in eyes with angle-closure glaucoma was 54.1+/-14.7
mmHg and in the partner eyes 22.4+/-8.6 mmHg preoperatively. Follow-up pressure
was 19.3+/-2.0 mmHg in eyes with angle-closure glaucoma and 18.8+/-1.5 mmHg in
the partner eyes.CONCLUSION: Primary cataract extraction including posterior
chamber lens implantation into eyes with angle-closure glaucoma reduced
intraocular pressure to normal levels, increased visual acuity, and decreased
the number of antiglaucomatous drugs. Eyes with angle-closure glaucoma do not
respond differently to phacoemulsification and lens implantation compared to
eyes with narrow angle without pressure elevation during and after
phacoemulsification.
-----
J Cataract Refract Surg. 2005 Aug;31(8):1549-1556.
Visual outcome of microincision cataract surgery with
implantation of an Acri.Smart lens.
Alio JL, Rodriguez-Prats JL, Vianello A, Galal A.
>From the Instituto Oftalmologico de Alicante Vissum Incororation (Alio,
Rodriguez-Prats, Vianello, Galal), Refractive Surgery and Cornea Unit,
Ophthalmology Department, Miguel Hernandez University, Medical School, Alicante,
Spain; Ophthalmological Institute (Vianello), La Sapienza University, Rome,
Italy; Research Institute of Ophthalmology (Galal), Cairo, Egypt.
PURPOSE: To evaluate visual and refractive outcome of microincision cataract
surgery (MICS) with implantation of an Acri.Smart 48S intraocular lens (IOL) (Acri.Tech)
through a sub-1.9 mm incision. SETTING: Vissum/Instituto Oftalmologico de
Alicante and Ophthalmology Department, Miguel Hernandez University, Alicante,
Spain. METHODS: In this consecutive prospective observational noncomparative
clinical trial, 45 eyes were included. Microincision cataract surgery was
performed through a 1.9 mm or smaller clear corneal incision using low
ultrasound power MICS. The IOL was injected using a hydraulic cartridge and
injector. The final size of the clear corneal incision, postoperative
uncorrected and best corrected near and distance acuities, lens stability, ease
of implantation, rate of posterior capsule opacification (PCO), and
complications were reported up to 6 months. RESULTS: The Acri.Smart lens was
inserted through mean incision of 1.5 mm +/- 0.3 (SD). The mean uncorrected
distance visual acuity improved significantly from 20/100 (0.2 +/- 0.2 decimal
value) preoperatively to 20/32 (0.7 +/- 0.3) by the end of 6 months
postoperatively (P<.000). The best corrected distance visual acuity improved
significantly from 20/50 (0.4 +/- 0.2) preoperatively to 20/25 (0.9 +/- 0.2)
after 6 months (P<0.000). The uncorrected near visual acuity at the end of 6
months was 20/32 (0.6 +/- 0.2, P<.000). The mean postoperative spherical
equivalent was -1.1 +/- 0.9 diopters (P<.947). The safety index was 2.5 for
distance and 1.4 for near. There were no intraoperative or postoperative
complications. No eye had a neodymium:YAG laser capsulotomy for PCO or reported
undesirable complications at the end of 6 months. CONCLUSIONS: Results show that
the Acri.Smart 48S IOL is a safe, effective, and stable lens that could be
inserted through sub-1.9 mm incisions. It provided excellent surgical
performance, predictability, and some degree of pseudoaccommodation.
-----
Can J Ophthalmol. 2005 Aug;40(4):454-459.
Secondary intraocular lens implantation of traumatic cataract in
open-globe injury.
Chuang LH, Lai CC.
Background: The purpose of this study was to determine the visual outcome and
accuracy of biometry in traumatic cataract in open-globe injury. Methods: A
clinical retrospective study of 30 consecutive patients treated for ocular
penetrating trauma was conducted. Patient demographics, causes of injury, wound
categories, timing and procedures of the primary repair, interval of subsequent
intraocular lens (IOL) implantation, follow-up, and postoperative complications
were recorded. Additionally, binocular biometry was documented. Twenty-six eyes
(86.7%) were open-globe injuries occurring in the workplace. All patients
received cataract extraction with primary repair of the penetrating wound, 18
eyes (60%) underwent trans pars plana vitrectomy with lensectomy and 12 eyes
(40%) underwent lens aspiration or extracapsular cataract extraction.
Simultaneously, 16 eyes (53.3%) underwent intraocular foreign body removal.
Results: The mean visual improvement after secondary IOL implantation was
statistically significant (p = 0.002). Seventeen eyes (56.7%) achieved final
best-corrected visual acuity of 20/40 or better. The mean deviation of final
refraction and target refraction was –0.69 +/- 0.56 diopter, and 23 eyes
(76.7%) were within 1 diopter based on biometry of the traumatic eye. In 18 eyes
(60%), the difference was within 1 diopter according to biometry of the fellow
eye. In 5 cases (16.7%), there was no improvement of vision because of central
corneal scar, secondary glaucoma, macular pucker, or recurrent retinal
detachment. Interpretation: The vision of patients with traumatic cataract in
open-globe injury was improved after prompt surgical intervention and subsequent
IOL implantation. A minority of patients experienced no change in vision or a
deterioration of vision due to irregular astigmatism caused by a corneal wound
or variable damage to the posterior segment. Using biometry of the injured eye
after primary repair was more accurate than using biometry of the fellow eye to
determine the power of the lens for IOL implantation in variable open-globe
injury.
-----
J AAPOS. 2005 Aug;9(4):330-5.
Combined intraocular lens implantation and glaucoma implant (tube
shunt) surgery in pediatric patients: a case series.
Tesser R, Hess DB, Freedman SF.
Duke University Eye Center, Durham, North Carolina.
Purpose: We sought to investigate the outcomes of children who underwent
simultaneous intraocular lens (IOL) implant and glaucoma implant surgery.
Methods: Medical records of all patients who underwent simultaneous IOL implant
and glaucoma implant surgery from January 1995 through August 2003 by a single
surgeon were reviewed. Criteria for success included intraocular pressure </=22
mm Hg, or judged adequate for glaucoma severity, without vision loss or
devastating complication. Results: The study included 9 eyes of 8 children who
had a mean age of 7.6 years (range, 1-16) and a mean follow-up time of 21 months
(range, 8.5-35 months) after simultaneous IOL (either cataract removal with
primary IOL, 2 eyes; or secondary IOL implantation, 7 eyes), and glaucoma
implant surgery (6 Baerveldt, 3 Ahmed). The indications for combined surgery
fell into 3 basic categories: unilateral aphakia with glaucoma (4/9), anatomical
features (such as shallow anterior chamber and/or vitreous in the pupillary
plane) making an IOL helpful in positioning the tube away from corneal
endothelium and/or vitreous (4/9), and unilateral traumatic cataract (1/9). Mean
intraocular pressure for operated eyes was 29 mm Hg (range, 21-44)
preoperatively and fell to 17 mm Hg (range, 11-22) at last follow up, P = 0.01.
The mean number of glaucoma medications was 3.5 preoperatively (range, 2-5)
versus 1.9 (range, 0-4) at last follow-up (p = NS). Complications (n = 5) were
varied, only 2 of which required additional surgery. Eighty-nine percent (8/9)
of patients met criteria for success at last follow-up. Conclusions: Selected
children can do well after combined glaucoma implant and IOL surgery, achieving
both satisfactory glaucoma control and stable visual acuity.
-----
Ophthalmology. 2005 Aug 9; [Epub ahead of print]
Intraocular Lens Implantation after Atopic Cataract Surgery
Decreases Incidence of Postoperative Retinal Detachment.
Inoue M, Shinoda K, Ishida S, Uchida A, Kurosaka D, Katsura H, Tsubota K.
Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
PURPOSE: To investigate the efficacy of intraocular lens (IOL) implantation in
reducing the incidence of postoperative retinal detachment after cataract
surgery in patients with atopic dermatitis. DESIGN: Retrospective review.
PARTICIPANTS: One hundred sixty-nine eyes of 126 patients who underwent cataract
surgery for atopic cataract were followed for more than 1 year. None of the eyes
previously had a retinal detachment or retinal detachment surgery. METHODS: The
eyes were divided into 132 eyes of 95 patients with an IOL implantation (IOL
group) and 37 eyes of 31 patients without an IOL implantation (aphakia group).
The postoperative visual acuity and incidence of postoperative retinal
detachment were compared between the 2 groups. The effects of the location of
the causative retinal breaks, intraoperative posterior capsule rupture, and
postoperative posterior capsulotomy on the incidence of retinal detachments were
evaluated. MAIN OUTCOME MEASURES: The postoperative corrected visual acuity,
incidence of postoperative retinal detachment, and influence of intraoperative
posterior capsule rupture on the retinal detachment. RESULTS: The final visual
acuity was better than or equal to 20/20 in 128 eyes (97.0%) of the IOL group
and in 29 eyes (78.4%) of the aphakia group (P = 0.0007). Retinal detachment
after an uncomplicated cataract surgery occurred in 3 eyes (2.3%) of the IOL
group and in 8 eyes (25.8%) of the aphakia group (P<0.0001, Mantel-Cox). Two of
3 eyes (66.7%) in the IOL group and 1 of 8 eyes (16.7%) in the aphakia group
that later developed a retinal detachment had an intraoperative posterior
capsule rupture. Posterior capsulotomy by yttrium-aluminum-garnet laser did not
seem to alter the incidence of postoperative retinal detachment in either the
IOL (2.0%) or the aphakia group (25.0%). CONCLUSIONS: The rate of postoperative
retinal detachment in eyes with IOL and no intraoperative posterior capsule
rupture seems to be low. Intraocular lens implantation with capsular bag
fixation may reduce the incidence of postoperative retinal detachment triggered
by lens surgery for atopic cataract.
-----
Curr Med Res Opin. 2005 Aug;21(8):1291-5.
A clinical comparison of two different prednisolone acetate
formulations in patients undergoing cataract surgery.
Gayton JL.
Eyesight Associates, Warner Robins, GA, USA. JLGayton@aol.com
PURPOSE: This study was conducted to evaluate the efficacy of two topical
steroid prednisolone preparations (Econopred Plus 1%, prednisolone acetate 1%:
EPP; Pred Fortedagger 1%, prednisolone acetate 1%: PF) in reducing postoperative
inflammation in cataract patients. METHODS: This was a 4 week, randomized,
parallel-group, single-center, active-controlled study. One group of patients
received postoperative topical EPP while the other group received postoperative
topical PF. Both medications were dosed 4 times per day for 14 days and then BID
until the container was empty. Both groups of patients received diclofenac
sodium QID for 14 days and hydroxypropyl guar (HP-Guar, Systane) QID for 7 days
then PRN (or as directed). The presence of corneal surface keratitis, anterior
chamber cells and flare (scales 0-3 for keratitis, 0-5 for cells and 0-4 for
flare; 0 = none) was evaluated by slit lamp biomicroscopy. RESULTS: EPP produced
significantly lower (P < 0.05) anterior chamber flare scores 14 days following
surgery (mean +/- SD: 0.86 +/- 0.53) than PF (1.08 +/- 0.40). Otherwise, there
were no differences observed between the 2 treatments with respect to keratitis,
anterior chamber flare or cells at postop days 1, 7, or 28. CONCLUSIONS: This
comparative trial demonstrated that both formulations of prednisolone acetate 1%
have similar efficacy in the treatment of postoperative ophthalmologic
inflammation.
-----
Ophthalmology. 2005 Jul 15; [Epub ahead of print]
Pars Plana Lensectomy and Intraocular Lens Implantation in
Pediatric Radiation-Induced Cataracts in Retinoblastoma.
Miller DM, Murray TG, Cicciarelli NL, Capo H, Markoe AM.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami
School of Medicine, Miami, Florida.
OBJECTIVE: To investigate visual outcomes, surgical complications, and tumor
recurrence among children with retinoblastoma (RB) undergoing pars plana
lensectomy, vitrectomy, and simultaneous intraocular lens insertion for
radiation-related cataract secondary to external beam radiotherapy (EBRT).
DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: The
medical records for all patients treated with pars plana lensectomy, vitrectomy,
and posterior chamber intraocular lens implantation for radiation-induced
cataract after EBRT for RB at a single institution between January 1, 1990, and
December 31, 2000, were reviewed. PARTICIPANTS: The study included 16 eyes of 12
children with Reese-Ellsworth stage V RB. MAIN OUTCOME MEASURES: Visual acuity,
surgical and postoperative complications, postoperative refraction, and tumor
recurrence. RESULTS: The median age at diagnosis of RB was 6 months (range, 1-49
months). All patients received EBRT as primary treatment and experienced
radiation-induced cataracts. The median interval from RB diagnosis to cataract
surgery was 42 months (range, 28-95 months). Preoperative mean visual acuity was
20/400, with 12 of 16 eyes (75%) having macular tumor involvement. All patients
underwent pars plana lensectomy, vitrectomy, and posterior chamber intraocular
lens insertion. Vitreous samples were evaluated by cytopathologic examination,
and no viable tumor cells were identified in any of the vitreous specimens.
Postoperative complications included transient cystoid macular edema in 5 eyes
(31%) and iridocyclitis in 3 eyes (19%). The mean follow-up after cataract
surgery was 66 months (range, 30-94 months). Final visual acuity was 20/40 or
better in 11 of 16 eyes (69%). No late intraocular recurrence, orbital tumors,
or metastatic disease was noted in this study. CONCLUSIONS: Pars plana
lensectomy, vitrectomy, and simultaneous intraocular lens implantation is an
effective means of managing EBRT-induced cataracts in eyes with previously
treated RB. There was no evidence of active tumor in eyes undergoing surgery at
least 28 months after the diagnosis and commencement of therapy for RB, and no
late intraocular, orbital, or metastatic tumors were detected. Visual acuity was
limited by the presence of primary macular tumor pathologic features in a subset
of patients, but final vision better than 20/400 may be achieved in these eyes.
-----
BMC Ophthalmol. 2005 Jun 22;5:15.
The combination of intravitreal triamcinolone and
phacoemulsification surgery in patients with diabeticfoveal oedema and cataract.
Habib MS, Cannon PS, Steel DH.
Sunderland Eye Infirmary, Queen Alexandra Road, SR2 9HP, UK. Maged.Habib@chs.northy.nhs.uk
BACKGROUND: The management of diabetic patients with refractory macular oedema
or patients with no adequate pre-operative view to administer laser treatment
provide a challenge to the ophthalmologist. We wished to assess the use, safety
and effect of intravitreal triamcinolone injection at the time of cataract
surgery in patients with diabetic foveal oedema and sight limiting lens
opacities. METHOD: This was a longitudinal non-randomised prospective pilot
study in 18 eyes (12 patients). All patients had visually significant lens
opacities and either persistent diabetic foveal oedema unresponsive to laser
treatment-group A, or foveal oedema with no adequate pre-operative view for
laser treatment- group B. The cataract surgery was carried out under full
aseptic technique using a self-sealing temporal incision and a foldable acrylic
lens. Intravitreal triamcinolone was given infratemporally pars plana at the
completion of the cataract surgery. The patients were reviewed at day 5, 2
weeks, 2 months and then every 3 months as required. The Wilcoxin matched-pairs
test was used to assess the significance of the improvement in visual acuity at
2 months. RESULTS: Twelve patients with a total of 18 eyes were included in the
study. There were 10 patients (15 eyes) in group A and 3 patients (3 eyes) in
group B. Preoperatively 16 of the 18 eyes had a visual acuity of 6/24 or worse.
Postoperatively 83% of patients had completely dry foveae at 2 weeks.
Best-corrected visual acuities at two months review ranged from 6/6 to CF with 9
eyes (50%) achieving 6/12 or better (7 eyes (47%) in group A and 2 eyes (67%) in
group B). Three eyes had no recorded improvement in visual acuity, but no eyes
had deterioration in acuity. The improvement in visual acuity was significant at
p = 0.001. There were no significant sight threatening complications.
CONCLUSION: Intravitreal triamcinolone has been shown to lead to an improvement
in macular oedema and visual improvement in diabetic patients not undergoing
cataract surgery but has not, to our knowledge, been previously used in a study
like this one.We suggest that intravitreal injection at the time of cataract
surgery could be carried out safely with encouraging visual outcomes in patients
with diabetic foveal oedema and cataract.
-----
Ophthalmology. 2005 May 6; [Epub ahead of print]
Cataract surgery for residual angle closure after peripheral
laser iridotomy.
Nonaka A, Kondo T, Kikuchi M, Yamashiro K, Fujihara M, Iwawaki T, Yamamoto K,
Kurimoto Y.
Department of Ophthalmology, Kobe City General Hospital, Kobe, Japan.
PURPOSE: To investigate the frequency of residual angle closure after resolution
of pupillary blocking by laser peripheral iridotomy and the effects of
subsequent cataract surgery to resolve angle closure completely. DESIGN:
Retrospective, consecutive, interventional study. PARTICIPANTS: Among 70 eyes
treated with laser iridotomy, 13 with residual angle closure were treated with
cataract surgery. METHODS: The provocative test of angle closure by prone
position in a dark room for 1 hour was performed; increases in tension of >/=8
mmHg, 6 or 7 mmHg, and </=5 mmHg were considered to be positive, suspected
positive, and negative, respectively. Configuration of the anterior chamber was
examined using ultrasound biomicroscopy (UBM). MAIN OUTCOME MEASURES:
Intraocular pressure (IOP), response to the dark room prone position test, and
morphologic analysis by UBM were evaluated before and 3 months after cataract
surgery. RESULTS: Residual angle closure after iridotomy was seen in 27 (38.6%)
of 70 eyes; this was confirmed functionally by the dark room prone position test
and morphologically by UBM. Eyes with IOP of >/=20 mmHg or with a glaucomatous
visual field defect before iridotomy had a significantly higher incidence of
residual angle closure after iridotomy than eyes without these findings
(P<0.05). In all the eyes with residual angle closure after iridotomy, the
response to the prone position test became negative after cataract surgery, with
significant lowering of IOP (P<0.01). CONCLUSIONS: Residual angle closure after
iridotomy was common, especially in eyes with primary angle closure and poorly
controlled IOP or glaucomatous optic neuropathy. Cataract surgery was effective
to resolve completely the residual angle closure after iridotomy and lower IOP.
-----
Cornea. 2005 May;24(4):406-9.
Preoperative injection of mitomycin C in combined pterygium and
cataract surgery.
Avisar R, Bar S, Weinberger D.
Department of Ophthalmology and External Eye Disease Clinic, Rabin Medical
Center, Petah Tiqva, Tel Aviv University, Israel. lavisar@bezeqint.net
PURPOSE: To evaluate the safety and efficacy of a preoperative injection of
mitomycin C (MMC) in combined pterygium and cataract surgery. METHODS: This was
a prospective, nonrandomized, interventional trial. Thirty-nine patients with
cataract and pterygium enrolled in a prospective, nonrandomized trial. All
patients underwent combined pterygium and cataract surgery. Twenty-seven
received a single 0.1-mL injection of 0.15 mg/mL MMC into the pterygium head 4
weeks before surgery and 12 did not. Patients were followed for 12 to 23 months
postoperatively. Recurrence of pterygium, side effects, and complications of MMC
were recorded. RESULTS: Recurrent pterygium developed in none of the patients
treated with MMC preoperatively and in 5 of the nontreated patients. Two
patients in the pretreated group had allergic conjunctivitis immediately after
MMC injection. No other local eye complications or adverse systemic reactions
were recorded. CONCLUSIONS: Preoperative injection of MMC into the head of the
pterygium 4 weeks prior to combined pterygium and cataract surgery resulted in
no recurrence and no serious complications up to 12 to 23 months of follow-up
postoperatively. This procedure may be recommended to save time and cost and to
prevent the possible side effects of MMC when administered topically at the time
of cataract surgery. Further follow-up and additional studies will be needed to
determine the long-term safety and efficacy.
-----
Graefes Arch Clin Exp Ophthalmol. 2005 Apr;243(4):321-6. Epub 2004 Oct 29.
Correction of pre-existing astigmatism during cataract surgery:
comparison between the effects of opposite clear corneal incisions and a single
clear corneal incision.
Ben Simon GJ, Desatnik H.
Goldschleger Eye Institute and Department of Ophthalmology, Sheba Medical
Center, Tel Aviv University, Tel Hashomer, Israel.
BACKGROUND: Opposite clear corneal incisions (OCCIs) have been reported to
reduce pre-existing astigmatism (PEA) during cataract surgery. Our goal was to
evaluate the effect of OCCIs on correcting PEA in cataract surgery.METHODS:
Non-randomized prospective study. Thirty-four patients with PEA of greater than
1.5 diopters (D) underwent clear cornea phacoemulsification cataract extraction
with 3.2-mm OCCIs (OCCI group). The control group consisted of 23 successive
patients with PEA <1.5 D who underwent cataract extraction without OCCI.
Best-corrected visual acuity, keratometry and refraction were recorded for all
patients pre-operatively and post-operatively.RESULTS: Using keratometric
findings, mean astigmatism correction was 1.3 D (+/-0.9 SD; decreased from 2.6 D
pre-operatively to 1.4 D post-operatively) in the OCCI group but only 0.4 D in
the control group (P<0.005), 8 months post-operatively. Vector analysis of
astigmatism correction showed greater change for OCCI patients (1.8 D vs 1.0 D,
P=0.002). Using the Holladay method for calculating surgically induced
refractive change (SIRC), the OCCI group showed a higher value of SIRC (-1.6 D
vs -0.97 D), but this was not statistically significant. The OCCI patients
showed a greater and significant change in refraction spherical equivalent than
the controls. No complications related to OCCI or cataract surgery occurred
during the follow-up period.CONCLUSIONS: Opposite clear cornea incision seems to
be a simple, predictable, safe and effective procedure in reducing pre-existing
corneal astigmatism in cataract surgery. It has an enhanced effect in correcting
astigmatism compared to a single clear cornea incision when using keratometric
findings value but not when using refractive data. Future studies are needed to
document the long-term effect of OCCI and to evaluate the correlation between
incisions of different size and astigmatism correction.
-----
Eye. 2005 Apr 22; [Epub ahead of print]
Effect of illumination on visual function after monofocal and
multifocal intraocular lens implantation.
Elgohary MA, Beckingsale AB.
[1] 1Ophthalmology Department, Essex County Hospital, Colchester, UK [2]
2University Ophthalmology Hospital, Tanta University Hospitals, Tanta, Egypt.
PURPOSE: To compare best-corrected visual acuity (BCVA) and contrast sensitivity
(CS) under different levels of illumination in patients who had monofocal and
multifocal intraocular lenses (IOLs) and to establish the effect of different
lighting conditions on vision in the two groups of patients. METHODS: We
retrospectively reviewed 27 patients who underwent phacoemulsification for
age-related cataract and IOL implantation of either monofocal (SI30NB; n=10,
37%) or multifocal (SA40N; n=17, 63%) IOLs. Binocular distance and near BCVA and
CS were tested using logMAR and Pelli-Robson charts that were externally
illuminated with 20, 200, 400, and 1600 lux, and were compared using
repeated-measures analysis of variance. A questionnaire was administered to
establish the lighting preference in the two groups and the effect of lighting
conditions on their vision. RESULTS: Binocular distance and near BCVA and CS
significantly increased with increasing illumination from 20 to 200 lux in the
monofocal (mean=0.04 vs -0.07; P=0.006; 0.37 vs 0.26, P=0.002 and 1.47 vs 1.60,
P=0.01) as well as in the multifocal group (mean=0.03 vs -0.12, P<0.001; 0.38 vs
0.23, P<0.001 and 1.47 vs 1.61, P=0.002). No significant difference in BCVA or
CS was found between the two groups at any of the four illumination levels. Both
groups had similar lighting preference, but 43.8% of patients in the multifocal
group experienced subjective worsening of their vision in bright outdoor lights.
CONCLUSIONS: Distance and near BCVA and CS improve with increasing illumination
in patients with monofocal and multifocal IOLs, but remain comparable in the two
groups under common levels of indoor illumination. Patients with multifocal IOLs
may experience worsening of their vision in bright outdoor lights.Eye advance
online publication, 22 April 2005; doi:10.1038/sj.eye.6701820.
-----
Acta Ophthalmol Scand. 2005 Apr;83(2):176-83.
Clinical outcomes of phacoemulsification cataract surgery in
diabetes patients: visual function (VF-14), visual acuity and patient
satisfaction.
Mozaffarieh M, Heinzl H, Sacu S, Wedrich A.
Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
PURPOSE: To evaluate the visual outcomes (visual acuity [VA] and visual
function) after phacoemulsification cataract surgery in patients with diabetic
retinopathy (DR), and assess patient satisfaction with final surgical outcome.
METHODS: This prospective study comprised 74 eyes of 74 patients with different
stages of DR. One surgeon (AW) performed all cataract surgery in a standardized
fashion. Patients were assessed using the VF-14 (Visual Function-14)
questionnaire. The following groups of patients were compared: those with no
apparent retinopathy; those with mild non-proliferative DR (NPDR); those with
severe NPDR, and those with proliferative DR (PDR). Visual acuity and visual
function questionnaire (VF-14) responses were recorded preoperatively and 3
months postoperatively, during which the non-operated fellow eye showed no
progression in retinopathy. RESULTS: Improvements in visual outcomes were
significantly higher in groups 1 and 2 compared to groups 3 and 4 (Tukey-Kramer,
p < 0.001). Comparisons between groups 1, 2 and 3, 4 showed significant
differences in improvements in VA (Tukey-Kramer, p < 0.01), yet no statistically
significant differences in functional (VF-14) improvements emerged between these
groups. CONCLUSIONS: Patients with more advanced levels of DR showed no
functional improvements despite improvements in VA. This emphasizes the
relevance of patient education prior to surgery. In particular, it should be
explained to patients with more advanced DR that, although surgery may be
required, their functional improvement may be limited.
-----
Zhonghua Yan Ke Za Zhi. 2005 Mar;41(3):200-4.
[Long-term follow-up of visual functions after pediatric cataract
extraction and intraocular lens implantation.]
[Article in Chinese]
Lai J, Yao K, Sun ZH, Zhang Z, Yang YH.
Eye Center, Second Hospital of Zhejiang University, Hangzhou 310006, China.
OBJECTIVE: To assess the visual acuity and binocular function of children after
pediatric cataract extraction and intraocular lens implantation. METHODS: 47
children with 68 eyes (< 13 years old) were included in the study: 12 children
with monolateral traumatic cataract, 14 children with monolateral congenital
cataract and 21 children with bilateral congenital cataract. Cataract type,
cataract extent, age at surgery and presence of strabismus and nystagmus and the
best corrected distant visual acuity (BCDVA) before surgery were recorded and as
well. In addition, the best corrected near visual acuity (BCNVA) and bionocular
function were followed up for an average of (41.3 +/- 12.3) months. Statistical
analysis was used to define factors that correlated with achieving good visual
acuity and binocular function. RESULTS: BCDVA and BCNVA were 0.5 or better in 34
eyes (50.0%) and a good binocular function was achieved in 18 children (38.3%).
Age at surgery, extent of cataract, absence of strabismus and nystagmus were
significant for good BCDVA. Age at surgery, absence of strabismus and nystagmus,
good BCDVA were significant for good binocular function. CONCLUSIONS: Good
visual acuity and binocular function can be achieved after pediatric cataract
extraction and intraocular lens implantation. Multiple factors correlated with
achieving good visual function such as timing of surgery, type and extent of
cataract, absence of strabismus and nystagmus etal.
-----
Arq Bras Oftalmol. 2005 Feb;68(1):29-35. Epub 2005 Mar 30.
Comparison of PMMA, foldable silicone and foldable acrylic
hydrophobic intraocular lenses in combined phacoemulsification and
trabeculectomy.
Serpa Junior E, Wishart PK.
Departamento de Glaucoma, Hospital Governador Celso Ramos, Florianopolis, SC.
PURPOSE: To compare the postoperative results of phacotrabeculectomy with
implantation of PMMA, foldable silicone or foldable hydrofobic acrylic
intraocular lens (IOL). SETTING: Glaucoma unit, The Royal Liverpool University
Hospital, Liverpool, United Kingdom. METHODS: We studied a total of 124 eyes of
three consecutive groups of patients with glaucoma and cataract that underwent
phacotrabeculectomy with implantation of a PMMA (30 eyes), a foldable silicone
(57 eyes) or a foldable acrylic (37 eyes) IOL. Postoperative Snellen visual
acuity and intraocular pressure (IOP), and early and late complications were
assessed. All data were analyzed by means of c(2) test, Fisher's exact test,
ANOVA/MANOVA tests or a combination whenever appropriate. RESULTS: In all three
groups the early and late mean postoperative IOPs were significantly lower than
the preoperative ones (p<0.001), with no intergroup differences (p=0.48). The
number of eyes with early postoperative hypertension (IOP>25 mmHg) and hypotony
(IOP<7 mmHg) was similar in the three groups (p=0.91 and p=0.92 respectively).
All groups showed improvement in mean visual acuity (p<0.001), and the
differences among the groups were not significant (p=0.79). By 9-12 months after
surgery IOPs lower than 22 mmHg without glaucoma medication were found in 76.9%
in the PMMA group, 76.6% in the silicone group and in 76.9% in the acrylic
group. At the same interval, best visual acuity of 6/12 or better was attained
in 80.8%, 83% and 80.8%, in the PMMA, silicone and acrylic groups respectively.
The silicone group had significantly more postoperative fibrin reaction into the
anterior chamber (p=0.01) and giant cell deposits on the IOL (p<0.0001) than the
PMMA and the acrylic groups. The rate of Yag laser posterior capsulotomy was
lower with the acrylic IOL (0%) than with the silicone (12.2%) or PMMA (13.3%)
IOLs (p=0.08). CONCLUSION: In patients with glaucoma and cataract,
phacotrabeculectomy with PMMA, silicone or acrylic IOL was equally effective in
lowering the IOP and improving visual acuity. However, incidence of fibrin
reaction and lens deposits was higher in those eyes which received a silicone
IOL. The PMMA and the acrylic groups did not differ with respect to
postoperative complications, but those eyes with an acrylic IOL had a lower rate
of posterior capsule opacification.
-----
Curr Opin Ophthalmol. 2005 Feb;16(1):44-52.
Surgical strategies in patients with cataract and glaucoma.
Verges C, Cazal J, Lavin C.
Institut Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona,
Spain.
PURPOSE OF REVIEW: This review analyzes the most relevant studies on current
surgical strategies to treat glaucoma patients with cataracts. RECENT FINDINGS:
No clear evidence has confirmed better results with trabeculectomy alone
compared with phacotrabeculectomy. Recent studies have reported successful
outcomes combining deep sclerectomy and two-site phacoemulsification. The
phacoemulsification cataract extraction will not vary the intraocular pressure
of patients with previous deep sclerectomy. Mitomycin C proved to be effective
in maintaining lower pressure levels with the combined surgery technique;
however, 5-fluorouracil did not show any improvement. Minimally invasive
cataract surgery reduces surgical trauma, making it possible to obtain better
results with combined surgery and previous glaucoma surgery. SUMMARY: The
surgical strategy decision must be customized to every patient. Only filtering
surgeries are recommended in glaucoma patients with incipient cataract. Combined
surgical procedures are recommended for progressive or advanced glaucoma.
Two-site phacotrabeculectomy with mitomycin C achieves better stabilized
results; however, combined phacoemulsification with deep sclerectomy or
viscocanalostomy achieves similar results with a lower rate of complications.
These promising findings need more study to be confirmed.
-----
Curr Opin Ophthalmol. 2005 Feb |